Clinical governance

Clinical governance is a framework through which health care organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will fl ourish. For critical care, clinical governance requires the culture, systems, and support mechanisms to achieve good clinical performance and ensure quality improvement is embedded into the unit’s routine. This includes action to ensure risks are managed, adverse effects are rapidly detected, openly investigated, and lessons learned, that good practice is rapidly disseminated and that systems are in place to ensure continuous improvements in clinical care. There must be systems to ensure all clinicians have the right education, training, skills, and competencies to deliver the care needed by patients. There must also be systems in place to recognise and act on poor performance.

The Critical Care Unit interfaces with most of the rest of the hospital and its clinical governance arrangements must contribute to patient care throughout the hospital. Some aspects of critical illness are managed outside the Critical Care Unit, yet the critical care team retains responsibility for ensuring quality and safety of this care.

Essential components of clinical governance

Clear management arrangements Everyone must know who they are accountable to, the limits of their decision-making, and who must be informed in the decision-making process.

Quality improvement

Through the process of clinical audit, the standard of practice is monitored and changes effected to improve quality.

Clinical effectiveness

Evidence-based practice is essential where sound evidence exists to

support clinical decisions. Protocols and guidelines standardise practice.

Risk assessment and management

A register of clinical risks should be kept, to which new risks are appended as they are assessed. An action plan should be developed for managing each risk and its implementation monitored.

Staff and organisational development

Including continued professional education, clinical supervision, and professional

regulation.

Patient input

Complaints monitoring should be used to learn lessons and improve practice within Intensive Care Unit (ICU). Patients’ and relatives’ suggestions and surveys can be used to adapt quality initiatives to the needs of patients.